The Role of Intensity Modulated Radiation Therapy (IMRT) Techniques in External Radiation Therapy on the Value of Organ at Risk (OAR) Nasopharyngeal Carcinoma: Literature Review
Corresponding Author(s) : Runggu Ompusunggu
runggurunggu494@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 10 No. 4 (2022): 2022 Volume -10 - Issue 4
Abstract
Nasopharyngeal carcinoma (NPC) is a malignant disease that exists in Asia, the development of imaging techniques and radiation therapy in the last 5 years has utilized 75% of diagnoses as nasopharyngeal carcinoma without metastases. The development of radiotherapy techniques has changed from conventional 2-dimensional (2D) to 3-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT). IMRT technique is one of the newest treatments at this time, so this technique requires a high level of precision and specific requirements either in immobilization or dose distribution, so that the accuracy rate for random or random systems is better than conventional 2D and 3D-CRT techniques. This study uses a descriptive qualitative method with a literature review study approach by collecting and analyzing data that aims to determine the role of the IMRT technique in external radiotherapy on the dose value of OAR for nasopharyngeal carcinoma. Based on the literature that forms the basis for the assessment, several advantages of the intensity modulated technique are shown. IMRT radiotherapy is capable of producing highly conformal doses with complex dose gradients, as well as being able to increase dose distribution within the target volume and reduce OAR doses.
Keywords
The role of IMRT technique in OAR nasopharyngeal carcinoma, nasopharyngeal carcinoma, linac
1.
Runggu Ompusunggu, I Wayan Juliasa, Maghfirotul Iffah. The Role of Intensity Modulated Radiation Therapy (IMRT) Techniques in External Radiation Therapy on the Value of Organ at Risk (OAR) Nasopharyngeal Carcinoma: Literature Review. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2023 Jan. 12 [cited 2025 Sep. 21];10(4):494-8. Available from: https://ijamscr.com/ijamscr/article/view/1278
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References
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1. Han F, Zhao C, Huang SM, Lu LX, Huang Y, Deng XW et al. Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol). 2012;24(8):569-76. doi: 10.1016/j.clon.2011.11.010, PMID 22209574.
2. Salehiniya H, Mohammadian M, Mohammadian-Hafshejani A, Mahdavifar N. Nasopharyngeal cancer in the world: epidemiology, incidence, mortality and risk factors. World Cancer Res J. 2018;5(1).
3. Zhang C, Liu LX, Li WZ, Liang W, Chen ZH, Huang XH et al. Cochlea sparing with a stratified scheme of dose limitation employed in intensity-modulated radiotherapy for nasopharyngeal carcinoma: a dosimetry study. Med Dosim. 2019;44(3):226-32. doi: 10.1016/j.meddos.2018.08.003, PMID 30268345.
4. Adham M, Kurniawan AN, Muhtadi AI, Roezin A, Hermani B, Gondhowiardjo S et al. Nasopharyngeal carcinoma in Indonesia: epidemiology, incidence, signs, and symptoms at presentation. Chin J Cancer. 2012;31(4):185-96. doi: 10.5732/cjc.011.10328, PMID 22313595.
5. Page BR, Hudson AD, Brown DW, Shulman AC, Abdel-Wahab M, Fisher BJ et al. Cobalt, linac, or other: what is the best solution for radiation therapy in developing countries? Int J Radiat Oncol Biol Phys. 2014;89(3):476-80. doi: 10.1016/j.ijrobp.2013.12.022, PMID 24929157.
6. Moon SH, Cho KH, Lee CG, Keum KC, Kim YS, Wu HG et al. IMRT vs. 2D-radiotherapy or 3D-conformal radiotherapy of nasopharyngeal carcinoma: survival outcome in a Korean multi-institutional retrospective study (KROG 11-06). Strahlenther Onkol. 2016;192(6):377-85. doi: 10.1007/s00066-016-0959-y, PMID 26972085.
7. Xu D, Li G, Li H, Jia F. Comparison of IMRT versus 3D-CRT in the treatment of esophagus cancer: a systematic review and meta-analysis. Medicine. 2017;96(31):e7685. doi: 10.1097/MD.0000000000007685, PMID 28767597.
8. Ng WT, Lee MC, Hung WM, Choi CW, Lee KC, Chan OS et al. Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys* Biology* Physics. 2011;79(2):420-8. doi: 10.1016/j.ijrobp.2009.11.024, PMID 20452132.
9. Sun Y, Yu XL, Luo W, Lee AW, Wee JTS, Lee N et al. Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. Radiother Oncol. 2014;110(3):390-7. doi: 10.1016/j.radonc.2013.10.035, PMID 24721546.
10. Tan W, Li H, G, Xu J, Wang x, Li Y et al. Target volume and position variations during intensity modulated radiotherapy for patients with nasopharyngeal carcinoma. Onco Targets Ther. 2013;6:179.
11. Lee AW, Ng WT, Pan JJ, Chiang CL, Poh SS, Choi HC et al. International guideline on dose prioritization and acceptance criteria in radiation therapy planning for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2019;105(3):567-80. doi: 10.1016/j.ijrobp.2019.06.2540, PMID 31276776.
12. Xu M, Zang J, Luo S, Wang J, Li X. Long-term survival outcomes and adverse effects of nasopharyngeal carcinoma patients treated with IMRT in a non-endemic region: a population-based retrospective study. BMJ Open. 2021;11(8): e045417. doi: 10.1136/bmjopen-2020-045417, PMID 34341036.
13. Cheung KY. Intensity modulated radiotherapy: advantages, limitations and future developments. Biomed Imaging Interv J. 2006;2(1):e19. doi: 10.2349/biij.2.1.e19, PMID 21614217.
14. Haberer-Guillerm S, Touboul E, Huguet F. Intensity modulated radiation therapy in nasopharyngeal carcinoma. Eur Ann Orl Head Neck Dis. 2015;132(3):147-51. doi: 10.1016/j.anorl.2014.02.008, PMID 25553970.
15. Han F, Zhao C, Huang SM, Lu LX, Huang Y, Deng XW et al. Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol). 2012;24(8):569-76. doi: 10.1016/j.clon.2011.11.010, PMID 22209574.
16. Sharbo G, Hashemi B, Bakhshandeh M, Rakhsha A. Assessment of developed IMRT and 3D-CRT planning protocols for treating nasopharyngeal cancer patients based on the target and organs at risks common volumes. Int J Radiat Res. 2022;20(2):307-15. doi: 10.52547/ijrr.20.2.8.
17. Jang-Chun L, Jing-Min H, Yee-Min J, Dai-Wei L, Chang-Ming C, Chun-Shu L et al. Comparisons of quality of life for patients with nasopharyngeal carcinoma after treatment with different RT technologies. Acta Otorhinolaryngol Ital. 2014;34(4):241-6. PMID 25210217.
References
1. Han F, Zhao C, Huang SM, Lu LX, Huang Y, Deng XW et al. Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol). 2012;24(8):569-76. doi: 10.1016/j.clon.2011.11.010, PMID 22209574.
2. Salehiniya H, Mohammadian M, Mohammadian-Hafshejani A, Mahdavifar N. Nasopharyngeal cancer in the world: epidemiology, incidence, mortality and risk factors. World Cancer Res J. 2018;5(1).
3. Zhang C, Liu LX, Li WZ, Liang W, Chen ZH, Huang XH et al. Cochlea sparing with a stratified scheme of dose limitation employed in intensity-modulated radiotherapy for nasopharyngeal carcinoma: a dosimetry study. Med Dosim. 2019;44(3):226-32. doi: 10.1016/j.meddos.2018.08.003, PMID 30268345.
4. Adham M, Kurniawan AN, Muhtadi AI, Roezin A, Hermani B, Gondhowiardjo S et al. Nasopharyngeal carcinoma in Indonesia: epidemiology, incidence, signs, and symptoms at presentation. Chin J Cancer. 2012;31(4):185-96. doi: 10.5732/cjc.011.10328, PMID 22313595.
5. Page BR, Hudson AD, Brown DW, Shulman AC, Abdel-Wahab M, Fisher BJ et al. Cobalt, linac, or other: what is the best solution for radiation therapy in developing countries? Int J Radiat Oncol Biol Phys. 2014;89(3):476-80. doi: 10.1016/j.ijrobp.2013.12.022, PMID 24929157.
6. Moon SH, Cho KH, Lee CG, Keum KC, Kim YS, Wu HG et al. IMRT vs. 2D-radiotherapy or 3D-conformal radiotherapy of nasopharyngeal carcinoma: survival outcome in a Korean multi-institutional retrospective study (KROG 11-06). Strahlenther Onkol. 2016;192(6):377-85. doi: 10.1007/s00066-016-0959-y, PMID 26972085.
7. Xu D, Li G, Li H, Jia F. Comparison of IMRT versus 3D-CRT in the treatment of esophagus cancer: a systematic review and meta-analysis. Medicine. 2017;96(31):e7685. doi: 10.1097/MD.0000000000007685, PMID 28767597.
8. Ng WT, Lee MC, Hung WM, Choi CW, Lee KC, Chan OS et al. Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys* Biology* Physics. 2011;79(2):420-8. doi: 10.1016/j.ijrobp.2009.11.024, PMID 20452132.
9. Sun Y, Yu XL, Luo W, Lee AW, Wee JTS, Lee N et al. Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. Radiother Oncol. 2014;110(3):390-7. doi: 10.1016/j.radonc.2013.10.035, PMID 24721546.
10. Tan W, Li H, G, Xu J, Wang x, Li Y et al. Target volume and position variations during intensity modulated radiotherapy for patients with nasopharyngeal carcinoma. Onco Targets Ther. 2013;6:179.
11. Lee AW, Ng WT, Pan JJ, Chiang CL, Poh SS, Choi HC et al. International guideline on dose prioritization and acceptance criteria in radiation therapy planning for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2019;105(3):567-80. doi: 10.1016/j.ijrobp.2019.06.2540, PMID 31276776.
12. Xu M, Zang J, Luo S, Wang J, Li X. Long-term survival outcomes and adverse effects of nasopharyngeal carcinoma patients treated with IMRT in a non-endemic region: a population-based retrospective study. BMJ Open. 2021;11(8): e045417. doi: 10.1136/bmjopen-2020-045417, PMID 34341036.
13. Cheung KY. Intensity modulated radiotherapy: advantages, limitations and future developments. Biomed Imaging Interv J. 2006;2(1):e19. doi: 10.2349/biij.2.1.e19, PMID 21614217.
14. Haberer-Guillerm S, Touboul E, Huguet F. Intensity modulated radiation therapy in nasopharyngeal carcinoma. Eur Ann Orl Head Neck Dis. 2015;132(3):147-51. doi: 10.1016/j.anorl.2014.02.008, PMID 25553970.
15. Han F, Zhao C, Huang SM, Lu LX, Huang Y, Deng XW et al. Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol). 2012;24(8):569-76. doi: 10.1016/j.clon.2011.11.010, PMID 22209574.
16. Sharbo G, Hashemi B, Bakhshandeh M, Rakhsha A. Assessment of developed IMRT and 3D-CRT planning protocols for treating nasopharyngeal cancer patients based on the target and organs at risks common volumes. Int J Radiat Res. 2022;20(2):307-15. doi: 10.52547/ijrr.20.2.8.
17. Jang-Chun L, Jing-Min H, Yee-Min J, Dai-Wei L, Chang-Ming C, Chun-Shu L et al. Comparisons of quality of life for patients with nasopharyngeal carcinoma after treatment with different RT technologies. Acta Otorhinolaryngol Ital. 2014;34(4):241-6. PMID 25210217.
2. Salehiniya H, Mohammadian M, Mohammadian-Hafshejani A, Mahdavifar N. Nasopharyngeal cancer in the world: epidemiology, incidence, mortality and risk factors. World Cancer Res J. 2018;5(1).
3. Zhang C, Liu LX, Li WZ, Liang W, Chen ZH, Huang XH et al. Cochlea sparing with a stratified scheme of dose limitation employed in intensity-modulated radiotherapy for nasopharyngeal carcinoma: a dosimetry study. Med Dosim. 2019;44(3):226-32. doi: 10.1016/j.meddos.2018.08.003, PMID 30268345.
4. Adham M, Kurniawan AN, Muhtadi AI, Roezin A, Hermani B, Gondhowiardjo S et al. Nasopharyngeal carcinoma in Indonesia: epidemiology, incidence, signs, and symptoms at presentation. Chin J Cancer. 2012;31(4):185-96. doi: 10.5732/cjc.011.10328, PMID 22313595.
5. Page BR, Hudson AD, Brown DW, Shulman AC, Abdel-Wahab M, Fisher BJ et al. Cobalt, linac, or other: what is the best solution for radiation therapy in developing countries? Int J Radiat Oncol Biol Phys. 2014;89(3):476-80. doi: 10.1016/j.ijrobp.2013.12.022, PMID 24929157.
6. Moon SH, Cho KH, Lee CG, Keum KC, Kim YS, Wu HG et al. IMRT vs. 2D-radiotherapy or 3D-conformal radiotherapy of nasopharyngeal carcinoma: survival outcome in a Korean multi-institutional retrospective study (KROG 11-06). Strahlenther Onkol. 2016;192(6):377-85. doi: 10.1007/s00066-016-0959-y, PMID 26972085.
7. Xu D, Li G, Li H, Jia F. Comparison of IMRT versus 3D-CRT in the treatment of esophagus cancer: a systematic review and meta-analysis. Medicine. 2017;96(31):e7685. doi: 10.1097/MD.0000000000007685, PMID 28767597.
8. Ng WT, Lee MC, Hung WM, Choi CW, Lee KC, Chan OS et al. Clinical outcomes and patterns of failure after intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys* Biology* Physics. 2011;79(2):420-8. doi: 10.1016/j.ijrobp.2009.11.024, PMID 20452132.
9. Sun Y, Yu XL, Luo W, Lee AW, Wee JTS, Lee N et al. Recommendation for a contouring method and atlas of organs at risk in nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. Radiother Oncol. 2014;110(3):390-7. doi: 10.1016/j.radonc.2013.10.035, PMID 24721546.
10. Tan W, Li H, G, Xu J, Wang x, Li Y et al. Target volume and position variations during intensity modulated radiotherapy for patients with nasopharyngeal carcinoma. Onco Targets Ther. 2013;6:179.
11. Lee AW, Ng WT, Pan JJ, Chiang CL, Poh SS, Choi HC et al. International guideline on dose prioritization and acceptance criteria in radiation therapy planning for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2019;105(3):567-80. doi: 10.1016/j.ijrobp.2019.06.2540, PMID 31276776.
12. Xu M, Zang J, Luo S, Wang J, Li X. Long-term survival outcomes and adverse effects of nasopharyngeal carcinoma patients treated with IMRT in a non-endemic region: a population-based retrospective study. BMJ Open. 2021;11(8): e045417. doi: 10.1136/bmjopen-2020-045417, PMID 34341036.
13. Cheung KY. Intensity modulated radiotherapy: advantages, limitations and future developments. Biomed Imaging Interv J. 2006;2(1):e19. doi: 10.2349/biij.2.1.e19, PMID 21614217.
14. Haberer-Guillerm S, Touboul E, Huguet F. Intensity modulated radiation therapy in nasopharyngeal carcinoma. Eur Ann Orl Head Neck Dis. 2015;132(3):147-51. doi: 10.1016/j.anorl.2014.02.008, PMID 25553970.
15. Han F, Zhao C, Huang SM, Lu LX, Huang Y, Deng XW et al. Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol). 2012;24(8):569-76. doi: 10.1016/j.clon.2011.11.010, PMID 22209574.
16. Sharbo G, Hashemi B, Bakhshandeh M, Rakhsha A. Assessment of developed IMRT and 3D-CRT planning protocols for treating nasopharyngeal cancer patients based on the target and organs at risks common volumes. Int J Radiat Res. 2022;20(2):307-15. doi: 10.52547/ijrr.20.2.8.
17. Jang-Chun L, Jing-Min H, Yee-Min J, Dai-Wei L, Chang-Ming C, Chun-Shu L et al. Comparisons of quality of life for patients with nasopharyngeal carcinoma after treatment with different RT technologies. Acta Otorhinolaryngol Ital. 2014;34(4):241-6. PMID 25210217.